Doctor fix for Santa Cruz County included in health reform bill

WASHINGTON -- A provision to raise payments for Santa Cruz County family doctors treating Medicare patients has made it into the House version of health care reform legislation released Thursday, according to Rep. Sam Farr, D-Carmel.

When Farr introduced a bill in June to resolve the inequities, political observers said it was likely to be folded into an overall health care reform measure.

The provision appears on page 408 in Section 1125 in the Affordable Health Care for America Act, HR 3962.

The provision would fix a problem making it difficult for older people to find a family doctor willing to see them for the price paid by Medicare.

Santa Cruz is among the 14 counties in California designated as rural, resulting in doctors being compensated $65 for an office visit by a Medicare patient compared to $74 in neighboring Santa Clara County, according to the Health Improvement Partnership of Santa Cruz County.

The underpayment makes it difficult to recruit general practitioners to Santa Cruz County.

"We are aggressively recruiting for this increasingly extinct type of a physician," said Dr. Lawrence deGhetaldi, who heads the Palo Alto Medical Foundation Santa Cruz division, which has 41 doctors specializing in family medicine and internal medicine. "We have had a net growth of zero primary care physicians over the past year."

A small handful, no more than five, will accept some new patients including commercial Medicare patients who have been waiting to gain access to primary care physicians, he added, adding that Farr's fix, if it passes, would not take effect until Jan. 1, 2011.

A newer physician group in the county, Dominican Medical Foundation, has grown to 28 primary care doctors, all of whom are open to new Medicare patients, according to operations director Matthew Robertson.

Farr acknowledged Thursday that the reform bill is emerging after "more than three months of debate, hearings and negotiation."

More work is ahead.

"The bill still has to pass the House floor and be reconciled with the Senate version, but the end is in sight," said Farr, adding the bill as crafted would provide coverage for millions, lower costs for everyone and maintain the choice that Americans expect.